Central African Republic: Uniting to fight the spread of malaria

The Malaria Workshop, organised by Medecins Sans Frontieres (MSF) and the Ministry of Health of the Central African Republic (CAR), brought together more than forty national and international actors to exchange information on strategies, prevention and treatment of malaria, with the aim of reducing excessive mortality and morbidity in the country, as a result of the disease. The final aim is the creation of a recommendation paper containing input for the revision of the country’s Malaria National Strategy for 2012-2015. Among those who attended the workshop were members of the Central African Republic Malaria National Program, other representatives of the national Ministry of Health (MOH), experts from the MSF Malaria Working Group and representatives from local and international non-governmental organisations.

“By organising this workshop, MSF provided an opportunity for players in the fight against malaria to share their experience, and together assess how malaria is being treated in Bangui and the country’s interior,”said Dr. Gustave Bobossi Serengbe, paediatrician and former Rector of the University de Bangui. The workshop also brought in key international donors in an attempt to increase funding for the fight against malaria in CAR. “Combating malaria is a high priority for us, so we are taking action on various levels, the key among them being: strategy, strengthening of existing systems, and operations for assisting Central Africa in the fight against malaria,” said Dr. Marie-Reine Jibidar, UNICEF’s regional counsellor for malaria in Libreville.

Malaria is holo-endemic in the Central African Republic. In 2009, the World Health Organization (WHO) reported 175,210 cases of malaria and 667 deaths resulting from the disease. The MOH estimates that 40% of the morbidity and 13.8% of the mortality in the country’s health-care institutions are linked to malaria. Also, within MSF health services, malaria represents the primary cause of morbidity and mortality, especially in children under the age of five. Out of a total of 582,253 patients treated on an out-patient basis in 2010, 45.9%, or 267,471, were diagnosed and treated for malaria. These data show a high number of cases throughout the year, with a major spike in July and August. On a country-wide basis, out of the 1,997 deaths recorded in 2009, 670 resulted from severe malaria and 330 resulted from anaemia. These two causes were therefore responsible for half of the deaths that occurred in 2009. The proportion was even higher among children under the age of 5. Of the 1,375 hospital deaths in this age group, 544 were due to malaria, against 270 due to anaemia, or 59.2% of the combined total.

The first day of the workshop began with a presentation by the National Strategy on Malaria by the Ministry of Public Health and Population (MSPP). Participants discussed malaria prevention systems, such as the distribution of mosquito nets and an awareness campaign on their use. “Everyone needs to take responsibility for the fight against malaria. Each person needs to protect his or her home and sleep under mosquito nets. Whenever someone contracts malaria they must go to hospital as quickly as possible,” said Laura O’Reilly, Head of Mission for the NGO, Mentor, who also made a presentation on Indoor Residual Spraying (IRS).

The second day of the workshop began with an introduction on simple malaria by professor Gustave Bobossi-Serengbe of the University of Bangui. “Malaria remains a serious problem among children because almost half of children who present for fever have malaria and the parents pay for the consultations, the drugs and make a contribution for blood,”he explained. Participants also discussed rapid diagnosis systems based on the taking of a single drop of blood and having it analyzed within a minute. This was followed by discussions on treatment systems and in-home treatment, based on the concept of having health officers available within communities to treat patients in their own homes, thereby making access to care available to everyone. Participants also discussed the treatment of severe malaria using injectable artesunate.

The final day of the workshop was devoted to the drafting of a document containing recommendations for the review of the National Strategic Plan 2012-2015. “Technically, there are five ways to fight malaria: allocate the qualified human resources that there are in the country: impose the use of a standardized, reproducible and reliable diagnostic methodology; follow the diagnostic steps shown on the flow charts that have been validated by the Department; accommodate those cases that can be treated in the field or cases that have to be referred, and follow and apply the international protocols based on WHO protocols that have been validated by the Department of Health,”suggested Dr. Gilles Chaumentin, Technical Advisor to the Department of Health.

At the close of the workshop the document was presented to partners and donors by Jonathan Fisher, Chair of MSF’s Medical Council, and workshop moderator.

Recommendations by workshop participants to partners and donors

With the aim of reducing morbidity and mortality due to malaria, primarily as it affects children and expectant mothers, the workshop:

- in the area of research, recommends the use of CAR’s research institutes to optimize the treatment of malaria within the country;

- in the area of diagnosis, the workshop recommends systematic diagnosis, that is, increasing the number of rapid tests to enable each suspected case be tested before being treated;

- in the treatment of severe malaria, the workshop recommends that the national protocol be updated to include the new WHO recommendations;

- in the area of prevention, the workshop recommends:

* Mosquito nets:

** recommends mass distribution to the general population and to expectant mothers

* Prevention among expectant mothers:

** appeals to donors to implement the current protocol on prevention among pregnant women